Provider Demographics
NPI:1457677189
Name:GUADAMUZ, ROBERTO JOSE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:JOSE
Last Name:GUADAMUZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 S SAN JACINTO AVE
Mailing Address - Street 2:STE. O
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5103
Mailing Address - Country:US
Mailing Address - Phone:951-654-5900
Mailing Address - Fax:951-654-5933
Practice Address - Street 1:1695 S SAN JACINTO AVE
Practice Address - Street 2:STE. O
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-654-5900
Practice Address - Fax:951-654-5933
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0276040Medicare UPIN